The Protocol for Sports Concussion Info Dissemination: Trust and Respect

My take, amidst researchers criticizing media

Matthew Futterman's piece in The Wall Street Journal Tuesday (subscription required) about sports concussion protocol is informative, well-reported and gripping; it features emerging research and diverse comment wrapped around the story of a teen football player's death.

But some researchers say this type of story is pushing kids off the field and onto the couch, and doing so without merit.

"The media need to learn that individual stories, however tempting, are meaningless scientifically," said Alan Carson, a neuropsychiatrist at the University of Edinburgh in Scotland. Speaking of soccer, he added: "In the U.K., every time somebody who was a famous footballer gets dementia, we get a news report that links it to football ... It seemed to me this was a public health scare."

Such reporting feeds public sentiment that contact sports such as football and hockey cause concussion and neurodegenerative disease, and discourage kids from being physically active. So say researchers in three separate pieces published recently. They lament that coverage is skewed away from the sports' health benefits, especially when evidence shows physical activity can improve public health.

"Millions of kids played football for generations and we don't see millions of kids walking into the neurologist at 40 years old saying they can't find their keys," said Steven Broglio, PhD, a University of Michigan brain injury researcher.

"Even if we accept that contact sports increase the risk of neurodegenerative disease," Carson said, calling that a dubious link, "there is no doubt at all that people who engage in active exercise live longer."

"I worry a whole generation of parents are pulling children off of sports because of misguided fear," he added. "We need to be more realistic about just how limited this evidence is" regarding sports and brain injury. Indeed, a recent Harris Poll survey commissioned by the American Osteopathic Association showed one in six parents ruling out sports entirely because of concussion risks -- while many underestimated the risk of non-contact sports such as gymnastics and cheerleading.

Such trends rankled some experts, to wit:

"Studies examining a connection between sporting head injury and outcome are necessary but it's unhelpful when the results are rushed to mainstream media outlets before proper consideration to interpretation, limitations, and replication," Carson wrote in Journal of Neurology, Neurosurgery & Psychiatry. "This is unfair on the public who are often unfamiliar with the technical problems in these studies."

"Unfortunately, data on the epidemiology of repetitive concussion and head-impact exposure in contact-sport athletes are limited," wrote brain injury researchers Michael McCrea, PhD, and Thomas McAllister, MD, in Journal of Athletic Training. "Without the necessary evidence to guide us, misguided policies could have unanticipated and unjustified consequences that encourage youth to refrain from the sport participation that we know can result in improved health, fitness, and the related psychosocial benefits."

"A vocal segment of the media has aimed a concomitant increase in negative publicity at organized sports," wrote Brian Hainline, MD, and Richard Ellenbogen, MD, neurologists who chair the NCAA's medical program and an NFL safety committee, respectively, in an editorial for Journal of Athletic Training. "The questions surrounding the risks of sport have transcended the scientific realm and become an existential threat to the survival of these activities. A rapidly evolving state of scientific evidence should be presented by scientists in a thorough and balanced manner, a feat now rendered nearly impossible by the highly volatile and emotional debate in the media."

That feat is not impossible, but "it's going to be a lot harder now," said Broglio, who guest-edited the JAT journal edition. "My mom challenges me," he said. "She said football will kill you. Really?! What have you read that I haven't, Mom? I live this all day. This is all that I do. We're really going to argue about it?"

These researchers have valid points -- even if, as Broglio joked, "there is no evidence" that the media focuses too much on the contact sports-brain injury link. We do report often on it, we know anecdotally, and not much on physical activity.

That's because brain injury studies offer new information, however confounding or insignificant scientifically. And reporting on physical activity's impact on health barely meets news standards: Do people need to be reminded why they should eat vegetables or brush their teeth?

Then there are the conflicts of interest, moral dilemmas and hyperbole permeating sports concussion research, which attract journalists like football players to a fumble. Ellenbogen and Hainline are allied with organizations that depend on a pipeline of young athletes for revenue. And they cite NFL- and NCAA-backed studies as potential solutions and call an athletic trainers association journal edition a step toward benefiting "society at large" in their editorial.

Do they ask us to back off contact sports because they truly think they need the space for research, or because they don't want that pipeline harmed?

"People are making an industry out of concussions," Carson said. "There are many conflicts of interest among researchers and an awful lot of money tied up in this research in a way that is not conducive to science." (Hainline and Ellenbogen could not be reached for comment.)

If kids are indeed shunning contact sports at the expense of physical activity, journalists and researchers are both at fault. In the digital age scholars love (have?) to showcase their work, often without sharing proper context, and journalists love (and definitely have) to publish early and often. There's a dissertation topic here, but I left that world.

So I will listen to researchers' complaint, but hear mine too: Don't go to Congress touting preliminary results that distort true findings; don't ask me to "stay on message" as the Sports Fitness Industry Association did when they interrupted my question for the NFL's youth programs director in March; stop using the Roger Goodell defense as Broglio did on the phone with me, reminding me there's risk in eating a Big Mac ("There's risk in everything you do"). I know, Steve; I saw "Super Size Me."

I'm encouraged by my conversations with researchers. For example: "Junior Seau is a massive story so it's going to get put out there," Broglio told me. "I understand why it happens," even if he considers such reporting a public "disservice."

We need more conversations like that. Everybody wants the same endpoint, no matter their short-term intentions. But if we don't trust and respect each other, we may not get there.